I have been given the following cases to solve in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and come up with a treatment plan.
2) pharmacological interventions
https://link.springer.com/article/10.1007/s00534-005-1050-8
1)fluid replacement
Increased vascular permeability in acute pancreatitis causes the loss of intravenous fluid and reduces plasma volume. In severe cases, in patients with massive ascites, pleural effusion, and retroperitoneal and mesenteric edema, circulating plasma volume decreases markedly. Hypovolemia may lead to shock and acute renal failure, and, because hypovolemic shock may impair the pancreatic microcirculation and promote pancreatic ischemia and necrosis, restoration and maintenance of plasma volume is crucial in severe acute pancreatitis.
2) antibiotics
On the other hand, a placebo-controlled, double-blind trial of ciprofloxacin + metronidazole in patients with predicted severe acute pancreatitis showed that prophylactic administration of these antibiotics did not prevent pancreatic infection (Level 1b).
3)analgesics
4) nebulization in view of b/l wheeze secondary to ?copd
5)diuretics for decreased urine output due to renal failure
Non pharmacological interventions
1)nill by mouth
https://pubmed.ncbi.nlm.nih.gov/27107634/
2)ryles tube catheterisation
3)oxygenation
Question 2:(55M)
https://aakansharaj.blogspot.com/2020/11/55-year-old-male-with-anemia.html?m=1
1)bone marrow and bones
2)kidneys
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205153/
The pathophysiology of renal failure in multiple myeloma is often multifactorial but is mostly due to the high excretion of immunoglobulin free light chains. When the light chains combine with Tamm-Horsfall proteins, they form obstructing casts (5). Chemotherapy should therefore be initiated rapidly to decrease light chain production. Intravenous fluids can be given to treat volume depletion, hypercalcemia, or hyperuricemia.
3)lungs(infection-incrsead susceptibility)
https://www.cancer.org/cancer/multiple-myeloma/causes-risks-prevention/what-causes.html
Researchers have found that patients with plasma cell tumors have important abnormalities in other bone marrow cells and that these abnormalities may also cause excess plasma cell growth. Certain cells in the bone marrow called dendritic cells release a hormone called interleukin-6 (IL-6), which stimulates normal plasma cells to grow. Excessive production of IL-6 by these cells appears to be an important factor in development of plasma cell tumors.
A) pharmacological interventions
1. Antibiotics (?aytpical pneumonia-azithromycin)
https://www.intechopen.com/books/update-on-multiple-myeloma/infections-in-patients-with-multiple-myeloma-in-the-era-of-novel-agents-and-stem-cell-therapies
However, the infections encountered in patients with MM include: (1) bacterial infections, predominantly involving respiratory and urinary tract, caused by Streptococcus pneumonia, Staphylococcus aureus, Haemophilus influenzae, Klebsiella pneumonia, Escherichia coli (2) viral infections caused by herpes simplex virus (HSV), VZV, and cytomegalovirus (CMV); (3) fungal infections caused by Candida species and Aspergillus species; and (4) Pneumocystis jiroveci pneumonia
2. Blood transfusion
B)non pharmacological
1. Pleural fluid analysis
2. Imaging -xray skull, hrct chest
3. Serum electrophoresis,sputum culture
Question 3)
http://nithishaavula.blogspot.com/2020/11/51-yr-old-male-with-hfref.html?m=1
1)pedal edema with abdominal distention with sob suggestive of right heart failure or renal failure
B)etilogy of rt heart failure
https://www.ncbi.nlm.nih.gov/books/NBK459381/
chronic conditions of pressure overload may lead to RVF. These include:
Primary pulmonary arterial hypertension (PAH) and secondary pulmonary hypertension (PH) as seen in chronic-obstructive pulmonary disease (COPD) or pulmonary fibrosis)
Congenital heart disease (pulmonic stenosis, right ventricular outflow tract obstruction, or a systemic RV).
The following conditions result in volume overload causing RVF:
Valvular insufficiency (tricuspid or pulmonic)
Congenital heart disease with a shunt (atrial septal defect (ASD) or anomalous pulmonary venous return (APVR)).
Another important mechanism that leads to RVF is intrinsic RV myocardial disease. This includes:
RV ischemia or infarct
Infiltrative diseases such as amyloidosis or sarcoidosis
Arrhythmogenic right ventricular dysplasia (ARVD)
Cardiomyopathy
Microvascular disease.
Lastly, RVF may be caused by impaired filling which is seen in the following conditions:
Constrictive pericarditis
Tricuspid stenosis
Systemic vasodilatory shock
Cardiac tamponade
Superior vena cava syndrome
Hypovolemia.
